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NPI Code Detail

MEDICARE: ELIZABETH WATERS LPT

MEDICARE: ELIZABETH WATERS LPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1087138TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18T7396OTHERTXBCBS

General Provider Information

NPI Number : 1629052212
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH WATERS LPT
Provider Business Mailing Address
First Line : PO BOX 60037
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78466-0037
Country : US
Telephone Number : 361-814-9898
Fax Number : 361-814-9897
Provider Business Practice Location Address
First Line : 14302 NEMO COURT
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78418-6238
Country : US
Telephone Number : 361-949-9898
Fax Number : 361-949-9897
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 11/07/2007

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